Normalizing Drug Use

America's focus is on eliminating drug use—we need to regulate and manage it

We have entered an era in which drug use is widespread, almost ubiquitous, and yet at the same it is viewed as unmanageable and uncontrollable. We need instead to accept and to regulate drug use.

Several recent key writings in the popular and academic press point to the following developments:

We are in a pharmacological era when drug use, both approved and unapproved, is widespread, almost universal.

We conceptualize drugs as invariant causes of behavior and resulting social dysfunction.

We respond to this situation by social and legal regulation, on the one hand, and medical regulation on the other.

Instead, we need to accept drug use as socially and psychologically regulatable behavior to be incorporated into modern life.

David Brooks argues that we have entered the age of the fool, as represented by Donald Trump, caused by our having ignored our Dionysian origins:

The early Christians seem to have worshiped the way David did, with ecstatic dancing, communal joy and what Emile Durkheim called “collective effervescence.” In her book “Dancing in the Streets,” Barbara Ehrenreich argues that in the first centuries of Christianity, worship of Jesus overlapped with worship of Dionysus, the Greek god of revelry. Both Jesus and Dionysus upended class categories. Both turned water into wine. Second and third century statuettes show Dionysus hanging on a cross.

But when the church became more hierarchical, the Michals took over. Somber priest-led rituals began to replace direct access to the divine. In the fourth century, Gregory of Nazianzus urged, “Let us sing hymns instead of striking drums, have psalms instead of frivolous music and song, … modesty instead of laughter, wise contemplation instead of intoxication, seriousness instead of delirium.”

But instead of suggesting that we have lost something, intoxication, essential that we need to incorporate into modern experience (a position Brooks personally rejects), he traces the rise of the Fool, as represented ultimately by Trump, that fills this gap, and says that he appears in two distinct forms, "the presidential level and the fool level. . . .His tweets are classic fool behavior. They are raw, ridiculous and frequently self-destructive. He takes on an icon of the official culture and he throws mud at it. The point is not the message of the tweet. It’s to symbolically upend hierarchy, to be oppositional. . . ." The latter should be ignored, he resolves.

Brooks's column appears at the same time that several academic works argue that we must go beyond our current regulatory approaches to deal socially, through non-pharmacological factors, with expansive, almost universal, drug use.

Hartogsohn, in a tour de force built around Norman Zinberg's work but as applied principally to psychedelics (his dissertation was on LSD, his principal referent is Timothy Leary), with a minor detour towards painkillers et al., argues:

To what extent are the effects of psychoactive drugs fixed and predictable, and to what extent are they a construction produced by society and culture? The question of “nondrug parameters of psychopharmacology,” as it was sometimes called in the 1960s (Feldman, 1963), has been debated extensively over the past century, yet it has still not been answered in full. We know about the significant role played by the placebo effect (Brown, 2012; Moerman, 2002), and we know that the effects of drugs can vary significantly between users across societies, cultures, and subcultures (Wallace, 1959), yet we are still lacking a solid working theory as to how and why that happens.

In a world which is growing increasingly skeptical of a long and failed war on drugs, and which is seeking alternatives in decriminalization, legalization, and a host of other approaches to drug reform (Boggs, 2015; Golub et al., 2015; Hari, 2015), the question of extra-pharmacological variables is becoming increasingly urgent. Studying the ways in which drug effects are shaped by social and cultural parameters is essential to developing effective strategies for harm reduction, and a more effective drug policy which would reduce drug harms and allow the emergence of more beneficial patterns of drug use.

Hartogsohn refers to Golub et al., who describe prevailing eras of drug use and regulation:

During the expansion phase, the pioneering drug users or medical advocates successfully introduce the practice to the broader population. In a very broad review of the literature, Everett Rogers [15] identified that when ideas spread they tend to spread with increasing rapidity, whether it involves a new consumer product, fashion, teaching method, or agricultural technique. Mathematically, many aspects of these “diffusion of innovation” processes are analogous to disease epidemics. The primary difference between social diffusions and disease epidemics is what is being spread—an idea or behavior as opposed to a bacteria or virus. People have agency regarding whether they adopt a behavior, such as use of a new drug, and many people choose not to. Regarding drugs, individual susceptibility to use varies greatly according to social networks, social and economic status, societal and structural constraints, and personal identity. It is the rapid growth in popularity during the expansion phase that shocks law enforcement, the media and other social institutions leading them to use and abuse the term “drug epidemic” to arouse concern and serve political agendas [16-18]. In this paper, we use the less emotionally charged phrase “drug era” to emphasize the cultural aspects of the phenomenon.

Drug eras eventually reach a plateau phase when everyone most at risk of the new drug practice either has initiated use or at least had the opportunity to do so. For a time, widespread use prevails. Eventually, the use of a drug may go out of favor. This leads to a gradual decline phase of a drug era. This shift can be precipitated by emergence of drug-related problems, the availability of a more desirable or fashionable drug, a policy intervention aimed to curtail use, a general cultural shift or a combination of these factors. During this phase, new conduct norms emerge that hold that use of a drug is bad or old-fashioned. The subsequent new norms and policies then compete with the prevailing pro-use norms. During the decline phase, a decreasing proportion of youths coming of age become users. However, the overall use of the drug generally endures for many years as some users continue their habits. We now use this framework to examine earlier drug eras. What differentiates many of these earlier eras from those of the late 20th century is that usage of the drugs of concern involved medical and social reasons as opposed to counter-cultural activity.

These are the drug eras Golub et al. identify with the current era the Expansive Era writ large:

What all of these approaches are pointing towards is an era where drug use is universal, and expanding, and yet we fail to recognize the social tools at our disposal to regulate it, starting with Zinberg's Set and Setting: The Basis for Controlled Intoxicant Use, which focuses primarily on heroin, which indicates that people's mind sets and life rituals and involvements dictate how drugs are used and experienced, up to and including addiction, as I describe in The Meaning of Addiction.

I live in probably the worst area of the country for drug use. In my area people have been dying from drug use all my life. It's a constant. If heroin and opioid use is new to an area, the population might be frightened and concerned about all the death and destruction that comes with it. I'm used to it.

Because of what I get to witness on a daily basis I've abstained from alcohol, drugs, cigarettes. I've led an extremely clean life.

But then I got sick, and I learned a few things.

My doctors were pretty horrified at my attitude toward pain killers. I was lectured by them to use them because it would greatly improve my quality of life and also limit my complaining.

I'm of the opinion my doctors were right. I learned that when one is in pain, pain killers make life bearable. I'm far from addicted to drugs. In fact, I still probably take far fewer drugs than most other people.

But.......

This is what I have found. Taking a pill, or half a pill, or a quarter of a pill when needed not only takes care of the immediate debilitating pain but allows me to move productively forward in the next day or week. If I don't take medication I can wallow in the after-affects of a pain spell for days, which means increased sleep time, depression and general lethargy.

In my mind I tend to visualize new things/fads/etc… of all kinds similar to things that splash in the water; there is wavy up and down use/acceptance initially, but (at least when calm heads prevail) people tend to let others live their own lives and matters level off.

The main problem, as I see it, and which I think is the point of your saying we must normalize drug use, is that when others appoint themselves everyone else's overlord and think they know best how to run everyone else's life, then we have what we have now: Koyaanisqatsi. Mass instability and anti-balance.

Straining out gnats but swallowing camels.

Interesting to read your comment about David Brooks; I saw him on TV explain how he came to work with Buckley. It seems Brooks shouted out some heckling-type remark in the middle of a large assembly when Buckley was speaking.

I have a thought. Stop talking to the academics, come down to earth, and simplify your message. The people who need your help won't understand a word you just wrote.

Maybe that doesn't concern you... you're more concerned with policy. My suggestion is to not waste your time. Those who are struggling need practical help. The question is: where is your time best spent.

We are reeling from a tone-deaf city and county public health department who have been sold on the idea of drug consumption sites from InSite in Vancouver. We can't get a word in edgewise. Evidence-based prevention and treatment what we need, but our local officials have decided to experiment with a "harm reduction" method that is not sanctioned in the U.S. It's frustrating that our County has less than 100 treatment beds, a growing homeless population (many of whom are addicts) and a inability to hear their citizens tell them, evidence-based prevention and treatment. The Surgeon General's Report "Facing Addiction in America" came out in November 2016 and does not mention drug consumption sites (or safe injection sites). CARA signed into law by President Obama last summer does not mention drug consumption sites. We need federal-level subject matter experts to talk some sense into these people. I want people to get their lives back.